Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study

Abstract

BackgroundIn 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk factors associated with high prevalence of HIV among HSWs in Larkana as compared to other cities of the country.MethodsData were extracted for secondary analysis from 2008 Integrated behavioral and biological survey (IBBS) to compare HSWs living in Larkana with those living in other cities including Karachi and Hyderabad in Sindh; Lahore and Faisalabad in Punjab; and Peshawar in Khyber Pakhtunkhwa provinces. After descriptive analysis, univariate and multivariate analyses were performed to identify risk factors. P value of 0.25 or less was used to include factors in multivariate analysis.ResultsWe compared 199 HSWs from Larkana with 420 HSWs from other cities. The average age of HSWs in Larkana was 26.42 (±5.4) years. Majority were Sindhi speaking (80%), uneducated (68%) and unmarried (97%). In univariate analysis, factors associated with higher prevalence of HIV in Larkana included younger age i.e. 20–24 years (OR: 5.8, CI: 2.809–12.15), being unmarried (OR: 2.4, CI: 1.0–5.7), sex work as the only mode of income (OR: 5.5, CI: 3.70–8.2) and longer duration of being involved in sex work 5–10 years (OR: 3.3, CI: 1.7–6.12). In multivariate logistic regression the HSWs from Larkana were more likely to lack knowledge regarding preventive measures against HIV (OR 11.9, CI: 3.4–41.08) and were more prone to use of alcohol during anal intercourse (OR: 6.3, CI: 2.77–17.797).ConclusionOutreach programs focusing on safer sexual practices and VCT are urgently needed to address the upsurge of HIV among HSWs in Larkana.

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India

“…MSM were informed that their participation, refusal to participate, or withdrawal from the study in no way would affect their services at Sahodaran. Hijra (transgender women) were not included in the current study, as previous studies have shown that hijra have a distinct set of needs and specific interventions should be designed to target gender minority populations (Altaf, Zahidie, & Agha, 2012; Phillips et al, 2013; Sahastrabuddhe et al, 2012). The assessment battery was administered in Tamil by a trained research assistant in a private room at the National Institute for Research on Tuberculosis in Chennai.…”

HIV risk and preventive interventions in transgender women sex workers

“…1,37,38 Several studies have described how male partners can be an important source of gender validation for transgender women, 15,21,23,24 which can undermine their intentions to engage in safer sex behaviour. 38,39 …”

HIV epidemics among transgender women

“…Also, data suggest that few transgender women know the HIV status of their sexual partners [29]. Lack of inclusion in HIV awareness and prevention campaigns as well as competing priorities in the lives of transgender women may contribute to low rates of HIV testing [30, 31]. …”